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Update on Effort to Fix New York Medicaid System

The New York Medicaid system is unique in the country for its size. The state serves more people (as a percentage) and provides more extensive benefits than any other state in the nation–by far. Of course, this all means that our program costs billions more per year than any other. Financial pressures are constantly threatening to alter the scope of support available to program participants, including New Yorkers who used Medicaid for elder care.

For this reason, all state residents have an interest in recent efforts to streamline the state program, crack down on fraud, and ensure all money spent is used properly and efficiently.

NY Medicaid’s Move Away from “Fee For Service”
Last week a Government Health IT story offered a helpful overview of some of the most recent changes to the NY system. It is noted that a commitment to putting the Medicaid system on better financial system does not necessarily mean that services will be cut. Instead, because of the bloated nature of the programs past, by eliminating fraud and transitioning away from expensive older models, care itself can be improved on top of financial savings.

Most notably, New York Medicaid continues to shift away from the “fee for service” model that long dominated medical and long-term care. This old model incentivizes more care (and costly care) instead of that which is most needed and best suited for the long-term well-being of the patient. Fortunately, as a result of the efforts of the “Medicaid Redesign Team,” fee for service arrangements are being axed. This has thus far slowed the growth of the program from an annual 13% increase to only 4% increase in yearly cost.

The leading figure in the movement is New York health commissioner Dr. Niravh Shah. Dr. Shah is pushing for more Medicaid funds to be used for novel payments, including at-home care for seniors and housing for at-risk individuals. The doctor recounted the challenge he faced when convincing lawmakers to abandon older models. When trying to get funding for more housing options for low-income patients via Medicaid, Shah noted, “They said no, ‘We don’t pay for bricks and mortar,. [I responded], Oh yes you do if it’s called a nursing home. And you trap people in there who don’t need a nursing home.”

The changes made thus far are only just the beginning, as Medicaid leaders in the state have an ambitious agenda. That includes the creation of a healthcare “ecosystem” that better prioritizes actual resident needs as opposed to the interests of entrenched service providers.

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